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◼ Perforation of anterior wall of duodenum à Leakage of contents to greater sac ➡right paracolic
Gutter and right iliac fossa
◼ Perforation of posterior wall ➡Massive bleeding due to perforation of gastroduodenal artery
◼ Perforation of Posterior wall of stomach leakage of contents to lesser sac
Fast adaptations ➡Pacinian > Meissner > Meckel’s disc > Hair-end > Krause > Baro-receptors
❖ Pacinian à High frequency vibration 80 to 400Hz
❖ Meissner’s à Low frequency vibration 02 to 40 Hz
◼Fascial palsy
1) A Paralysis oF Lower face sparing of upper face, location of Lesion
#Cortex ✔
Explanation -> In supranuclear corticobulbar palsy lesion
➢ Sparing of upper face is Because of bilateral supply
➢ Involvement of lower face is because of contralateral supply
2) fascial weakness on right side (deviation of jaw to left side), Unable to abduct right eye,
Hemiplegia on left side, location of Lesion
#Pons ✔
Explanation
➢ Millard Gibbler syndrome (ventral pons CN 6 ,7 ans CST are affected)
➢ Ipsilateral fascial palsy
➢ Ipsilateral abducent nerve palsy
➢ Contra lateral Hemiplegia
3) Right sided fascial palsy, loss of taste on Right sided anterior two third of tongue, Deafness and
vertigo. Location of lesion
Ans. CP angle✔
Explanation
At Cp angle 7th cranial nerve is in close proximity to 8th cranial nerve
4)Right sided fascial weakness, Loss of taste over right sided anterior 2/3rd of tongue, right sided
hyperacusis, Pain in eardrum and decreased lacrimation. Lesion is at
Ans. GENICULATE ganglion proximal to superficial greater petrosal nerve ✔
Explanation
Features a) Loss of taste on anterior 2/3rd b) Hyperacusis lesion proximal to stapedius c) Pain in ear
drum à geniculate ganglion involved
Loss of lacrimation à lesion proximal to superficial greater petrosal nerve
5) Right sided fascial weakness, Loss of taste on right anterior 2/3rd of tongue, Hyperacusis,
Lacrimation normal. Lesion is in
Ans. Fascial canal distal to geniculate ganglion ane proximal to nerve to stapedius ✔
Explanation
Ipsilateral LMN fascial palsy, Hyperacusis➡Leison proximal to nerve to stapedius
Normal à Lesion distal to superficial greater petrosal nerve
6) Right sided fascial palsy, loss of taste on anterior 2/3rd of tongue, Hearing and lacrimation normal
Ans. Lesion in facial Canal distal to nerve to stapedius and proximal to chorda tympani
ECG
➢ P Wave → Atrial Depolarization
➢ Q → Septal Depolarization
➢ R → Early Vent. depolarization (potential travelling to apex of vents)
➢ S → Late Vent. depolarization (Potential travelling to base of vents)
➢ T → Vent. repolarization
➢ U → Delayed repolarization of Purkinje system or papillary muscles
Conduction pathways
➢ SA / AV Node → 0.05 m/S
➢ Atrial Pathways / Vent Myocardium / Bundle of His → 1 m/S
➢ Purkinje System → 4 m/S
Cachexia
Which of the following is not characteristic of hypopituitarism?
a. Cachexia b. Infertility c. Pallor d. Low BMR
▪️ Cachexia means “weakness and wasting of the body (weight loss) due to severe chronic illness”.
Q- 22-year-Old man Sickle cell anaemia, active complaints pallor lethargy headache. Lab are HB is 4.6
retic is 3%. Parvovirus infection is suspected, what is ur diagnosis◼
A) thrombotic crisis B) sequestration crisis C) hemolytic crisis D) aplastic crisis✔✔
Explanation
➢ Sequestration crisis à Sickling of RBCs with in organs like spleen or lungs. Acute chest syndrome
very painful
➢ Aplastic crisis à Infection with parvovirus. Sudden fall in HB
➢ Haemolytic crisis ➡Rare ➡Fall in Hb due to increase haemolysis
➢ Thrombotic or painful crisis ➡Painful or vaso-occlusive ➡Precipitated by infection, dehydration
and deoxygenation ➡avascular necrosis of head of femur, hand foot syndrome in children
➢ Bladder carcinoma
Risk factors in order of frequency
◼Squamous Cell Carcinoma
Schistosomiasis > calmatte Guerin treatment> smoking◼
◼Transitional Carcinoma
Smoking > Exposure to aniline Dye in printing industry > Rubber manufacture > cyclophosphamide
ACL Prevents
1. Ant dislocation of tibia on femur
2. Post dislocation of femur on tibia
PCL Prevents
1. Ant dislocation of femur on tibia.
2. Post dislocation of tibia on femur
Q- Coagulopathy related to liver disease which clotting factor is characteristically increased?
A) factor V111 ✔ B) factor 2 C) factor IX D) factor 7 E) factor 12 F) none
Explanation
In liver failure all clotting factors are low except for factor 8 which is paradoxically supranormal cx it
is synthesized by endothelial cells throughout the body. And for clearance of activated factor 8 good
hepatic function is required, leading to increased circulating level of factor 8.
➢ RESPIRATION_PHYSIOLOGY
Between trachea and alveolar sac, the respiratory tract divides for 23 times. First 16 divisions are
conducting zone up to terminal bronchioles. The rest are gas exchange zones
Movement of diaphragm accounts for 75% change in intrathoracic volume during quite inspiration
Most of the work of breathing (65%) is to overcome ELASTIC RECOIL (past MCQ). Other are airway
resistance (28%) and viscous resistance (7%)
In the upright position, the ventilation per unit volume is greater at the base of the lung than that of
apex… the reason is intrapleural pressure is less negative at the base so alveoli are less expanded. At
the apex, the intrapleural pressure is more negative and alveoli are more expanded i.e. the %age of
max lung volume is greater. Because of the stiffness of the lung, the increase in lung volume per unit
increase in the pressure is smaller when lung is initially more expanded so ventilation is
consequently more at base.
Exercise is reported to increase the 2,3 DPG in 60 minutes… but in trained athletes this rise may not
occur
Four important functions of Hb. 1. Transport of O2. 2. Transport of CO2. 3. Buffer. 4. Transport of NO
Chloride shift is mediated by a protein called BAND 3 one of the major membrane proteins.
Of approximately 49ml of CO2 in dl of the ARTERIAL blood 2.6 ml is dissolved, 2,6 ml is carbamino
compound and 43.8 ml is in bicarb form. In tissue 3.7 ml is added. O.4 ml stays in solution, o.8 ml
forms carbamino compound and 2.5 ml forms bicarb
Carotid and aortic bodies(GLOMUS) is made of TYPE I and TYPE II cells surrounded by fenestrated
sinusoidal capillaries. Type I cells are called glomus cells which resemble chromaffin cells of adrenals
and release catecholamines upon exposure to hypoxia and cyanide.
► The Commonest Neuropathy related to Child Birth à Meralgia paresthetica (Neuropathy of the
Lateral Femoral Cutaneous Nerve )
Causes of gingival hyperplasia ...
⬛ Phenytoin
⬛ Cyclosporine
⬛ Calcium channel Blockers (Nefidipine) ☡mCQ
⬛ Carbamazipine
⬛ Acute myeloid leukaemia (monocytic type) Asim MCQ
➢ Grey baby syndrome à Chloramphenicol
➢ Red man syndrome à Vancomycin
➢ Grey man syndrome à Amoidarone
ATT Drugs
➢ Streptomycin à Ototoxity.
➢ Isoniazid à Hepatotoxicity.
➢ Pyrazinamide à Gout
➢ Rifampacin àOrange red colour urine
Protamine
➢ Protamine sulphate in normal standard does leads to Hypotension as side effect
➢ Protamine sulphate if given in excess of its recommended does can cause Paradoxical
anticoagulation leading to bleeding ...
➢ Remember difference between Normal dose & excess dose
Anti-Thyroid in Pregnancy
➢ 1st Trimester: PTU
➢ 2nd & 3rd : Methimazole
➢ Drug which crosses placenta and is teratogenic: Methimazole
➢ Drug which can cross Placenta: PTU, Methimazole, Thyroxine
To get relieve from sickness
➢ Acetazolamide for mountain sickness
➢ Scopolamine for motion sickness
➢ Pyrodixine for morning sickness
➢ Mecolzine for Air sickness
Oestrogen OCPs
Oestrogen containing OCPs à Inc. risk of Thromboembolism > Breast CA
High Oestrogen containing OCPs à Inc. risk of endometrial CA
Low Oestrogen containing OCPs à Inc. risk of Hepatic Adenoma
Thyroid Fever Investigations: Pneumonic BASU
➢ B=Blood, A=Antibody, S=Stool, U=Urine
1stweek = blood culture 2ndweek = antibody/ Widal
3rdweek = stool 4thweek = urine culture
Pathological Conditions
➢ Premalignant change in mouth à Chronic ulcer
➢ Premalignant Condition à Lichen planus
➢ Premalignant Lesion (Most common) à Leucoplakia
➢ Premalignant Lesion (Most lethal) à Erythroplakia
➢ Bettlenut chewing à Submucosal fibrosis
Defecation
➢ 1. Colon to Rectum à mass movement + myenteric reflex
➢ 2. Rectum to anal canal thru internal sphinter à rectoanal reflex
➢ 3. Exit thru ext sphincter à parasympathetic relex
➢ 2 + 3 together are called as defecation reflex
➢ 3 is better as its final pathway. Mass movement just adds defecation reflex
Some flavour of Ganong
●Pan-hypopituitarism is not associated with Cachexia (Ganong bcq).
●Room temp 21 °Humidity 80% heat is lost from uncovered body by -> Radiation and conduction.
●Diabetic Autonomic neuropathy manifests in GIT as Gastroparesis (Rx is Metoclopramide and
constipation ( Katzung pharma).
●Which of the following has the greatest effect on Na excretion ==ALDOSTERONE (Ganong mcq).
●Which of the following has the greatest effect on plasma osmolality ==VASOPRESSIN (ADH)
●Aldosterone main site of action==Cortical collecting ducts (Ganong MCQs).
●The pressure diff between the heart and aorta is least in the. Left ventricle during systole.
●Injection tPA is more beneficial in mi during 2nd hour of occlusion of Coronary artery. Ganong
1.Damage to Pneumotaxic Centre à Deep Breathing (normally prevent excessive deep breathing)
2.Damage to Apneustic Centre à Shallow Irregular breathing (Normally promotes deep breathing)
3.Transection above the level of pons à No effect on respiration
4.Transection at Mid-Pontine Level with Vagi Cut à Apneusis
5.Transection at Ponto-Medullary Junction à Irregular breathing
6.Transection Below Medulla à Stoppage of Respiration.
Saliva Secretions
>> Hypotonic >> high potassium bicarb (⬆ K ⬆ HCO3) >>low sodium Chloride (⬇ NA⬇ CL so hypotonic)
Pancreas secretions
>> isotonic both at high and low flow >> At low flow Mainly Sodium chloride(⬆ NA⬆ CL)
>> At high flow sodium bicarbonate (⬆ Na ⬆ HCO3) mainly
Gut specific sites for absorption of Minerals
• Duodenum à iron and calcium
• Terminal ileum à B12 and Bile salts
• Jejunum à Folic acid
• Colon à short chain fatty acids
► The Commonest Neuropathy related to Child Birth → Meralgia paresthetica (Neuropathy of the
Lateral Femoral Cutaneous Nerve)
► The commonest Lobe affected by Congenital Lobar Emphysema → Left Upper Lobe
►The Most Specific Diagnostic Test for H. Pylori Infection → Microbial Culture
► Commonest cause of Chronic Hypercalcemia → Primary Hyper-PTH
► Commonest opportunistic infection in HIV-infected individuals → Mycobacterium tuberculosis
► Commonest opportunistic infection in AIDS pneumonia → Pneumocystis Jiroveci
► Commonest organism to cause pneumonia in HIV → Streptococcus Pneumonia
► Commonest FUNGAL infection in HIV/AIDS → Candidiasis
►Commonest neurological manifestation in HIV infection → AIDS Dementia Complex
► Commonest skeletal muscle disorder → Inflammatory Myopathy
► Commonest Lymphoma in HIV → Immunoblastic NHLs
► Commonest HIV associated HODGKINS LYMPHOMA → Mixed cellularity HL
► Window Period of HIV → 2-4 weeks (By PCR)
► Highest Risk of opportunistic infection, CD4+ count will be → < 200/mm3
► Most Specific Test for AIDS → Western Blot
► Most Sensitive Test for AIDS → ELISA
► Confirmatory test for AIDS in Child born to HIV infected mother → PCR (up to age of 18 months)
► Commonest Haematological manifestation in AIDS → Autoimmune Haemolytic Anaemia
► Commonest organism to cause Meningitis in AIDS → Cryptococcus
►Commonest Space occupying tumour of Brain → Primary CNS Lymphoma
► Commonest Space occupying CNS lesion in ADS → Toxoplasmosis
► Commonest cause of seizures in AIDS → HIV Encephalopathy
► Commonest dermatological Manifestation in AIDS → Seborrheic Dermatitis
Malaria
• Type of Anaemia in Malaria →Normochromic Normocytic anaemia
• Species causing most deaths → P. Falciparum
• Species with Longest intrahepatic / Pre-Erythrocyte phase → P. Malaria (15 d)
• Species that cause relapse → P. vivax > P. ovale
• Species with longest duration of Erythrocytic phase → P. Malaria 72hrs (Quartan)
• Drug of choice for prevention of Relapse → Primaquine
• Drug of choice for severe falciparum malaria → Articulate (2nd Artemether, 3rd Quinine
dihydrochloride 4th Quinidine)
• Most common severe complication of falciparum malaria in children → `Cerebral Malaria
• Decrease delivery of oxygen to tissue à CO poisoning ✔
• Decrease Utilization of oxygen at tissue level àCyanide poisoning✔ (histotoxic hypoxia)
Anatomy
➢ C1-C2 VERTEBRA: vocal cords
➢ C2-oropharynx and soft palate with mouth open
➢ C3-hyoid bone
➢ Level of larynx in infants-C2-C3
➢ Level of larynx in adults-C3-C6
➢ C3-C4: bifurcation of common carotid artery
➢ C4 &C5-thyroid cartilage
➢ C6-cricoid cartilage
➢ C6-begining of trachea
➢ C6-begining of oesophagus
➢ C7-vertebra prominence
➢ Thyroid lobe superior extent-oblique line of thyroid cartilage
➢ Isthmus of thyroid gland-2nd through 4th tracheal rings
➢ Thyroid lobe inferior extent-sixth tracheal ring
➢ Spine at root of scapula-opposite third thoracic spine
➢ Thoracic inlet-T1
➢ Superior angle of scapula-overlies part of 2nd rib-1st intercostal space superior to angle/T2
➢ Jugular notch-T2&T3 vertebral junction
➢ Carnia-T3-4 or T4
➢ Manubrium Sterni-T3&T4
➢ Sternal angle-T4&T5
➢ Body of sternum-T5to T9 vertebra
➢ Greater splanchnic nerve-T5-T9 sympathetic ganglia
➢ Apex of heart/mitral value-5th intercostal space
➢ Base of heart/supine position-T5 to T8 vertebra
➢ Base of heart/erect position-T6 to T9
➢ Oblique fissure of lung-T6
➢ Inferior angle of scapula-T7
➢ Vena caval foramen-T8
➢ Xiphoid process-T9
➢ Xiphisternal joint-T9 vertebra typically
➢ Oesophageal hiatus-T10
➢ Termination of oesophagus-T11
➢ Lesser splanchnic nerve-T10-T11 sympathetic ganglia
➢ Least splanchnic nerve- T12 sympathetic ganglion
➢ Aortic hiatus-T12
➢ Coeliac trunk branch of abdominal aorta-T12
➢ Median arcuate ligament of respiratory diaphragm- T12 &L1 junction
➢ Pulmonary valve-left 2nd intercostal space medial
➢ Aortic valve-right 2nd intercostal space
➢ Tricuspid valve-right lower sternum
➢ Nipple in male-4th intercostal space in midclavicular line
➢ Trans pyloric plane-L1
➢ Celiac trunk-L1 superior border
➢ Superior mesenteric artery-L1 inferior border
➢ Pylorus of stomach-L1
➢ 1st part of duodenum-L1
➢ Left renal vein-L2
➢ 2nd part of duodenum-L1, L2, L3right side
➢ 3rd part of duodenum-L3
➢ Left crus of diagphram-L2
➢ Right crus of diagphram-L3 vertebra
➢ Inferior mesenteric artery-L3
➢ Subcoastal plane-L3
➢ Spinal cord termination à ► L1 in adults ► L3 in New borns
➢ Spleen-obliquely along axis of 10th rib
➢ Right kidney à ► Superior pole-T12 ► Inferior pole-L3 ► Hilum-L1
➢ Left kidney à ► Superior pole-T12 ► inferior pole-L3 ► Hilum-L1
➢ Pancreases head-L2&L3
➢ Umbilicus (in supine/recumbent position)-disc between L3-L4
➢ Bifurcation of abdominal aorta-L4
➢ Supracristal plane/highest point on iliac crest-L4
➢ Trans tubercular plane-L5
➢ Origin of inferior vena cava-L5
➢ Anterior superior iliac spine-S1/sacral promontory
➢ Posterior superior illiac spine-S2
➢ Pubic symphysis-tip of coccyx
►► Haemodynamic in the feto-placental circulation
➢ Fetal blood flow through placenta → 400 mL/min
➢ Pressure in the umbilical artery → 60-70 mmHg
➢ Pressure in the umbilical vein → 10 mmHg
➢ Oxygen Saturation in in the umbilical artery → 60%
➢ Oxygen Saturation in in the umbilical Vein 70-80%
➢ Partial pressure of oxygen in the umbilical artery → 20-25mmHg
➢ Partial pressure of oxygen in the umbilical Vein → 30-40 mmHg
➢ In Potter's syndrome ocular anomalies include cornea, glaucoma, cataract and prolapse of the
lens and expulsive haemorrhage in one eye.
➢ Marfan à superiotemporal lens dislocation, no corneal defect, high IQ compared to
homocysteinuria
➢ Homocystinuria à inferionasal lens dislocation, there is low IQ. In Homocysteinuria everything is
high except lens dislocation and IQ.
➢
Ulcers
• Martorell à Uncontrolled HTN
• Marjolin à SCC/ External Burn
• Meleny à Microaerophilic strep/ staph
• Cushing à raised ICP (gastric)
• Curling à Inhalational burn (gastric)
• Trophic/ Neurotrophic ulcer à Untreated Lower Limb venous ulcers
• Malum Perforans Pedis à Trophic Ulcer on Sole of foot
►Desmin #muscle
►Keratin #epithelial
►Vimentin #mesenchymal
►Neurobibrillin #neuron
►GFAP #Oligodendro
►S100 #Melanoma
►Chromogranin or 5HIAA #Carcinoid
►Neuron specific enolase #small cell cancer
►Blue cells à Ewing medulloblastoma and kulchitsky cells of small cell lung cancer
Thyroid
►Primary hypothyroidism (Thyroid dysfunction) ⬇ T3 T4 & ⬆ TSH
►Secondary hypothyroidism ⬇ T3 T4 & ⬇ TSH à If TSH is low Now give TRH
➢ If TSH increases means hypothalamic disorder cx pituitary is functional (tertiary hypo)
➢ IF TSH does not increase It means Pituitary disorder (secondary hypo)
Cell cycle
• Chromosome 1st appear in Prophase
• Thickest and best studied at Metaphase
• Parallel chromatids > Prophase
• Prominent chromatids > Metaphase
• Dividing chromatids > Interphase
• Double chromatids > Telophase
• Radiosensitive à G2/M
• Radio resistant à S
• Chemo sensitive à S phase
• Longest phase à G1
• Shortest à M
• Prophase of à M phase longest
• Anaphase of à M phase shortest
◼Cerebral Blood Flow /Oxygen/glucose
• Cerebral Blood Flow #50ml /min/100gm of tissue
• Glucose extraction is 5mg /min/100gm of tissue
• Brain consumes 20%of total systemic oxygen delivered
• Brain oxygen consumption is 3.5 ml/min/100gm of tissue
Anatomy
◼Sensory neurons are myelinated first
◼Primary somatosensory cortex area à3,2,1
◼Premotor Cortez area à 6
◼Frontal eye field area à 8
◼Primary motor area à 4
◼Primary auditory cortex superficial temporal area à 41, 42
◼Wernicke’s area à 22
◼Brocas area à 44
◼Association cortex à 5, 7
◼Difference between somatosensory and motor cortex à granular layer
◼Supply of basal ganglia à straiate artery
◼Labyrinthine artery branch of à AICA
◼Anterior choroidal artery branch of à ICA
◼Corpus collosum contain à Commissural fibres
◼Internal capsule contain à projection fibres
◼Tarsal Bones 7 in number
◼ Calcaneum Largest tarsal bone
◼ Cuneiform forms Transverse arch of foot
◼ Talus has no muscular attachment
◼ Nerve affected in tarsal tunnel syndrome à tibial
◼ Locking of knee -> Quadriceps femoris
◼ Unlocking of knee-> Popliteus muscle
◼Stomach ulcer à commonest site in Stomach à Near Angularis Incisura on lesser curvature
◼Gastric Cancer à commonest site in Stomach à Pyloric Antrum along the lesser curvature
▪️ The Lesions
➢ Facial lesion on same side of body à UMN Lesion >> Uncrossed hemiplegia
➢ Facial lesion on opposite side of body à PONS / brainstem >>> crossed hemiplegia
➢ Lesion on ant 2/3 of tongue >>> lesion in facial canal (cords tympani in facial canal)
➢ Bell’s palsy >>> lesion in stylomastoid foramen (muscular branches here >> muscular loss)
Q- Right hemiplegia with right facial nerve palsy
A) Lesion in internal capsule ✔ B) pons
➢ Facial lesion n truncal LOSS on same side (uncrossed lesion) = UMN lesion ✔
Q- Right hemiplegia with left facial nerve palsy lesion in
A) Internal capsule B) pons ✔
➢ Facia lesion opposite to TRUNKAL LOSS (crossed Hemiplegia) = LMNL Pons ✔
Q- Right sided hemiplegia plus right sided facial palsy lesion most likely in
a) Internal capsule ◼ b) Cortex c) Pons d) Cerebellum e) Midbrain
Q- Sensory loss on left side face n left side body. Level of lesion
A. Thalamus ✔ B. Pons C. Internal capsule D. Medulla
➢ Sensory loss >>> Thalamus
Q- A patient has stroke and presents with weak right limbs, mandible deviated to left upon
protrusion, anesthesia f face n scalp. Lesion is in
a. Pons ✔ b. Medulla c.trigeminal nerve d. posterior limb of internal capsule
➢ Here mandible Is deviated on protrusion ✔
➢ Not the angle of mouth deviated due unopposed muscles like in UMNL
➢ Don’t confuse with post limb of internal capsule. it contains just corticospinal fibres pathway
➢ Nothing to do with cranial nerves nuclei
Q- Pt has sensory and hemiparesis on R side of body with involvement of left side cranial nerves and
constricted pupil, lesion is at the site of
A) pons B) internal capsule C) medulla ✔ D) midbrain
Typical features lateral medullary syndrome symptoms
Unilateral constricted pupil Horners syndrome with sensory n hemiparesis.
Q- 59 yrs old hypertensive pt presented in Emergency in coma with left side hemiplegia n pinpoint
pupils lesion
A) internal capsule B) medulla C) pons ✔ D) basal ganglia
Bilateral Pin point pupil >>> always think Pons first ✔ followed by vomiting & COMA
As efferent sympathetic (usually causing pupillary dilatation) are interrupted, but the
parasympathetic fibres are unaffected. Again don’t let the Right n left confuse you
Q- Patient with right side body weakness and mouth deviate to left side during talking lesion is at
A) pons B) internal capsule ✔ C) cerebropontine
➢ Uncrossed lesion >> internal capsule. Here >>> Rt side body weakness is mention
Again don’t confuse with left deviated mouth. Which is due to weak RT facial muscles & unopposed
left facial muscles
Q- Patient presents with paralysed right arm n leg right plantar up going and exaggerated reflexes
lesion
A. left internal capsule✔ B. right cortex C. left cortex D. basal ganglia
➢ UMN lesion >> exaggerated reflexes
➢ With left cortex >> neglect, dressing apraxia & joint loss of joint sensation
Q- Least contribution to plasma osmolarity
a) Urea b) Protein ◼
Q- Artery arise from ext carotid art ascend forward in the neck deep to the post belly of diagastric
and stylohyoid muscle and then passes deep to the submandibular gland
A. facial artery ✔ B. lingual artery C. maxillary artery
Q- Deep to posterior digastric and near palatoglossus a structure runs obliquely upwards?
a) lingual Artery ◼ b) Facial artery
Q- Vertical artery runs obliquely upwards under submandibular gland iz
a) Lingual artery b) Facial artery ◼
➢ Vertical artery under submandibular >>>> facial
➢ Oblique >> Lingual
Q- Artery arise from ext carotid art ascend forward in the neck deep to the post belly of diagastric
and stylohyoid muscle and then passes deep to the submandibular gland
a) facial artery ✔ B. lingual artery C. maxillary artery
➢ Submandibular >> facial
Q- Branch of external carotid artery which arises from medial side, behind the posterior belly of
diagstric muscle in substance of parotid gland is
a) Ligual artery b) Occipital artery c) Facial artery
d) Ascending pharyngeal artery ✔ e) Superior thyroid artery
➢ Posterior auricular >> ascending pharyngeal artery
Q- True about External Carotid
a. Crossed by lingual artery and divides into facial and temporal terminal
b. Lateral to retromandibular vein ◼◼
c. lies anterior to diagastric muscle
➢ A option wrong - Divided into superficial temporal n maxillary artery
➢ C option - lies behind the substance of posterior belly of diagastric muscle. Crossed superficially
by marginal mandibular branch of facial nerve
➢ B option - Lies lateral to retro mandibular vein at the tip of mastoid angle of mandible
Q- Which nerve is most likely damage during 3rd molar surgical removal
a) inf alveolar nerve b) lingual nerve ✔
➢ tip of tongue sensation loss as well >> lingual
➢ Inferior alveolar is deep sited
Q- Regarding chorda tympani
a. carries taste from post 1/3rd of the tongue
b. joins lingual nerve after existing from skull ✔
c. passes medial to long process of incus
d. carries parasympathetic fibers from lacrimal Nucleus
Q- Which of the following nerve can be damaged during parotid gland surgery?
a) marginal mandibular branch of facial nerve ✔ B) lingual nerve
Q- While a surgery on Submandibular gland which has more chances of injury:
A. Superior thyroid artery B. Lingual nerve C. Mandibular nerve D. Facial nerve ✔
➢ Marginal branch of mandibular >> facial
Q- Facial Nerve in temporal bone give
A. Greater Petrosal neve ✔ B. Lingual Nerve > branch of Mandibular
Q- Roof of infratemporal fossa is pierced medially by foramen ovale through which pass
a. Facial Nerve b. Mandibular Nerve ◼ c. Maxillary Nerve d. Middle meningeal Vessel
Q- artery which can be palpated under the mandible near angle of jaw is
a. Facial ✔ b.ingual c. maxillary d. ascending pharyngeal
Q- blood suply of central forehead or midline of flap of forehead
a) frontal branch of frontal artery
b) paired supra trochlear artery ◼
c) ophthalmic branch of trigeminal artery
d) facial artery
e) paired supra orbital artery
Q – A pt has come with taste loss on anterior 2/3rd of tongue due to facial palsy. if is damaged in???
a) facial nucleus b) facial canal ✔ c) parotid gland d) stylomastoid
Q- regarding facial nerve
a. mylohyoid b. post belly of digastric ✔ c. chorda tympani arise from horizontal part
➢ Innervates>>> stylohyoid
Q- Max blood flow per minute?
a) Kidney b) Liver✔ c )Heart d)Brain e) Skin
Q- Least blood flow per minute?
a) Kidney b) Liver c )Heart ◼ d)Brain e) Skin
Q- Max blood flow per 100 gram of tissue?
a) Kidney ◼ b) Liver c ) Heart d)Brain e) Skin
Q- Which organ has Max O2 consumption?
a) Kidney b) Liver✔ c )Heart d)Brain e) Skin
Q- Max O2 consumption per 100 gram of tissue?
a) Kidney b) Liver c )Heart ◼ d)Brain e) Skin
Q- Least O2 consumption
a) Kidney b) Liver✔ c )Heart d)Brain e) Skin ◼
Q- Max O2 extraction from the blood?
a) Kidney b) Liver✔ c )Heart ◼ d)Brain e) Skin
Q- 15-year-old female presents with recurrent sinopulmonary infection. What test is most likely to
confirm primary immunodeficiency?
a. IgG level ✔ b. IgM level
Explanation. Most common primary immunodef is igA def but it is most commonly asymptomatic
Most common clinically significant immune deficiency is CVID (common variable immune deficiency)
It is characterised by 3 features Hypogammaglobulinemia of two or more subtypes IgG, IIgA or IgM.
Most important IgG in Recurrent Sino-pulmonary infection & impaired functional antibody response